Abstract
This study describes the implementation and outcomes of the first protocolized Ketogenic Diet Clinic (KDC) in Mexico for pediatric drug-resistant epilepsy (DRE). We conducted a retrospective analysis of 20 patients with DRE who initiated KDT between July 2022 and July 2024 in a multidisciplinary KDC at a public tertiary hospital. All patients were newly started on KDT under a structured protocol; none followed a classic 4:1 ketogenic diet, all received modified regimens. Clinical, nutritional, and socioeconomic data were collected. Seizure outcomes were categorized by percent reduction, and antiseizure medication (ASM) burden was evaluated through changes in cumulative daily dose and ASM count. Hospital admissions were recorded, and caregivers were asked about barriers to implementation. At the first follow-up visit (≈3 months), with complete data for all 20 patients, 10/20 (50 %) achieved ≥50 % seizure reduction and 4/20 (20 %) achieved ≥90 % reduction. Due to staggered recruitment, later visits included fewer patients (n = 18 and n = 14). Among the 14 patients who reached the third visit, 9/14 (64 %) achieved ≥90 % reduction. ASM dose decreased in 12/20 (60 %), and ASM count decreased in 6/20 (30 %). Hospital visits declined from 16 events the prior year to 4 after KDT initiation. Despite cultural, nutritional, educational, and access-related barriers, no patient discontinued the diet, as treatment plans were adapted to maintain feasibility. A structured KDC is feasible and clinically beneficial in a resource-limited setting. Modified KDT regimens reduced seizure burden and treatment intensity, supporting expansion of KDT programs in low-resource contexts.